【摘要】 目的：探讨术前超声影像学特征联合BRAF V600E突变检测对临床淋巴结阴性（clinically node-negative,cN0）甲状腺微小乳头状癌（papillary thyroid microcarcinoma,PTMC）患者中央区淋巴结转移（central lymph node metastasis,CLNM）风险的预测价值，为个体化手术决策提供依据。方法：回顾并分析2022年3月—2024年2月于山西省肿瘤医院术前诊断为cN0 PTMC并行甲状腺切除术联合中央区淋巴结清扫术的患者临床资料。术前行彩色多普勒超声评估肿瘤特征，检测甲状腺功能指标并通过细针穿刺活检标本检测BRAF V600E突变状态。根据术后病理学检查结果将患者分为无转移组和转移组，采用单因素及多因素logistic回归明确中央淋巴结转移的独立预测因子，并构建联合预测模型，通过受试者工作特征（receiver operating characteristic,ROC）曲线评估其预测效能，并通过DeLong检验比较联合预测模型及单独应用的诊断效能。结果：共纳入126例患者，其中无转移组72例，转移组54例。单因素分析表明，两组在年龄、数量、最大径、被膜侵犯、BRAF V600E方面比较，差异有统计学意义（P<0.05）。多因素logistic回归分析表明，年龄≤45岁、数量多灶、最大径>6 mm、被膜侵犯、BRAF V600E突）均是cN0 PTMC患者发生CLNM的独立预测因子。联合预测模型的曲线下面积（area under curve,AUC）为0.925(95%CI 0.878～0.972)，高于单独应用超声特征（AUC=0.681,95%CI 0.588～0.774）及BRAF V600E(AUC=0.618,95%CI 0.520～0.716)，差异有统计学意义（P<0.05）。结论：联合术前超声影像学特征与BRAF V600E突变检测可显著提高cN0 PTMC患者CLNM风险的预测效能，有助于筛选需行预防性中央区淋巴结清扫的高危人群，优化手术策略并降低过度治疗风险。更多还原

【Abstract】 Objective: To investigate the predictive value of combining preoperative ultrasonographic imaging characteristics with BRAF V600E mutation testing for central lymph node metastasis(CLNM) risk in clinically node-negative(cN0) papillary thyroid microcarcinoma(PTMC) patients, aiming to guide individualized surgical decision-making. Methods: Clinical data from cN0 PTMC patients preoperatively diagnosed and undergoing thyroidectomy with central lymph node dissection at Shanxi Cancer Hospital from March 2022 to February 2024 were retrospectively analyzed. Preoperative color Doppler ultrasound was performed to evaluate tumor characteristics. Thyroid function indicators were detected, and BRAF V600E mutation status was detected via fineneedle aspiration biopsy specimens. Based on postoperative pathology, patients were categorized into non-metastatic and metastatic groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of CLNM, followed by the construction of a combined prediction model. Receiver operating characteristic(ROC) curves were used to evaluate predictive performance, and DeLong’s test was applied to compare diagnostic efficacy between the combined model and individual predictors. Results: Univariate analysis revealed significant differences between the two groups in age, multifocality, tumor size >6 mm, capsular invasion, and BRAF V600E mutation status(P<0.05). Multivariate logistic regression identified age ≤45 years, multifocality, tumor size >6 mm, capsular invasion, and BRAF V600E mutation as independent predictors of CLNM. The combined prediction model achieved an area under the ROC curve(AUC) of 0.925(95% CI 0.878–0.972), significantly higher than ultrasound features alone(AUC=0.681, 95% CI 0.588–0.774) or BRAF V600E mutation testing alone(AUC=0.618, 95% CI: 0.520–0.716)(P<0.05). Conclusion: The combination of preoperative ultrasonographic features and BRAF V600E mutation testing significantly improves the predictive accuracy for CLNM risk in cN0 PTMC patients. This integrated approach facilitates the identification of high-risk candidates for prophylactic central lymph node dissection, thereby optimizing surgical strategies and minimizing overtreatment risks.更多还原